Determinants of Incident Malnutrition in Community-Dwelling Older Adults: A MaNuEL Multicohort Meta-Analysis

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Abstract

Objectives: To identify determinants of incident malnutrition in community-dwelling older adults. Design: Meta-analysis of 6 community-based longitudinal datasets with follow-up of 1 to 3 years. Setting: Datasets from MaNuEL (MalNutrition in the Elderly) partners were included: 3 studies from Germany and 1 each from Ireland, the Netherlands, and New Zealand. Participants: community-dwelling adults aged 65 and older (N=4,844). Measurement: The same definition of incident malnutrition was used for all cohorts (body mass index < 20.0 kg/m2 at follow-up or weight loss ≥10 % between baseline and follow-up). Twenty-one potential baseline determinants from 7 domains (demographic, nutritional, lifestyle, social, psychological, physical functioning, medical) and 2 follow-up variables (hospitalization, falls) were harmonized for all studies. Binary logistic regression analyses were performed to assess the association between each variable, adjusted for specific confounders, and incident malnutrition. Combined odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects meta-analyses. Results: Studies included between 209 and 1,841 participants without malnutrition at baseline; mean age ranged from 71.7 to 84.6. Incidence of malnutrition varied from 5.1% and 17.2%. Meta-analyses identified 6 variables as independent determinants of incident malnutrition; with increasing age, the risk of developing malnutrition increased continuously. Unmarried, separated, or divorced participants were more likely to develop malnutrition than married participants, whereas no association was found for widowed participants. Participants with difficulty walking (OR=1.41, 95% CI=1.06–1.89) or difficulty climbing stairs (OR=1.45, 95% CI=1.14–1.85) and those who were hospitalized before baseline (OR=1.49, 95% CI=1.25–1.76) and during follow-up (OR=2.02, 95% CI=1.41–2.88) had higher odds of incident malnutrition. Conclusion: In this harmonized meta-analysis based on prospective data of older, community-dwelling adults, age, marital status, limitations with walking and climbing stairs, and hospitalization were identified as determinants of incident malnutrition. J Am Geriatr Soc 66:2335–2343, 2018.

Original languageEnglish
Pages (from-to)2335-2343
Number of pages9
JournalJournal of the American Geriatrics Society
Volume66
Issue number12
Early online date23 Aug 2018
DOIs
Publication statusPublished - Dec 2018

Funding

The KORA study was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. The MaNuEL knowledge hub supported the preparation of this article. This work is supported by the Joint Programming Initiative Healthy Diet for a Healthy Life. The funding agencies supporting this work are (in alphabetical order of participating Member State): Germany: German Federal Ministry of Food and Agriculture through the Federal Office for Agriculture and Food (Grants 2815ERA10E (FAU) and 2815ERA08E (UUlm)); Ireland: Department of Agriculture, Food and the Marine and Health Research Board Project Reference 15/HDHL/2 MANUEL; The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw 50-52905-98-499). We would like to thank all research collaborators of the underlying studies. TILDA thanks Lauren Power for her support. LiLACS NZ wishes to acknowledge participants, their families, and whanau for supporting the study. We thank Te RōpuKaitiaki o ngā tikanga Māori for their guidance. We acknowledge the community partners in LiLACS NZ who engaged with participants and collected data (Western Bay of Plenty Primary Health Organisation, Ngā Matāpuna Oranga Kaupapa Māori Primary Health Organisation, Te Korowai Aroha Trust, Te Rūnanga o Ngati Pikiao, Rotorua Area Primary Health Services, Ngati Awa Research and Archives Trust, Te Rūnanga o Ngati Irapuaia, Te Whanau a Apanui Community Health Centre). This work was presented in a MaNuEL symposium at the 39th Congress of the European Society for Clinical Nutrition and Metabolism (ESPEN) in The Hague, Netherlands, and at the 13th Congress of the European Union Geriatric Medicine Society (EUGMS) in Nice, France, both in September 2017. The KORA study was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. The KORA-Age project was financed by the German Federal Ministry of Education and Research (BMBF FKZ 01ET0713 and 01ET1003A) as part of the ‘Health in Old Age’ program. The MaNuEL knowledge hub supported the preparation of this article. This work is supported by the Joint Programming Initiative Healthy Diet for a Healthy Life. The funding agencies supporting this work are (in alphabetical order of participating Member State): Germany: German Federal Ministry of Food and Agriculture through the Federal Office for Agriculture and Food (Grants 2815ERA10E (FAU) and 2815ERA08E (UUlm)); Ireland: Department of Agriculture, Food and the Marine and Health Research Board Project Reference 15/HDHL/2 MANUEL; The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw 50-52905-98-499). Conflict of Interest: All authors declare no conflict of interest. Author Contributions: MS data analysis, meta-analyses, drafted manuscript. MS, JZP, LB, GN, RT, CM: individual data analyses. MS, JZP, LB, GN, RT, CM, MC, GT, EK, EG, MV, DV: standardized study protocol, statistical analysis plan, list of confounders. DV and MV are the co-coordinators of the MaNuEL project. All authors read the manuscript, contributed comments to its revision, and approved the final version. Sponsor's Role: The sponsors played no role in this study. The KORA-Age project was financed by the German Federal Ministry of Education and Research (BMBF FKZ 01ET0713 and 01ET1003A) as part of the ‘Health in Old Age’ program.

FundersFunder number
Department of Agriculture, Food and the Marine and Health Research Board
Ngati Awa Research and Archives Trust
Ngā Matāpuna Oranga Kaupapa Māori Primary Health Organisation
Rotorua Area Primary Health Services
Te Korowai Aroha Trust
Te Rūnanga o Ngati Irapuaia
Te Rūnanga o Ngati Pikiao
Friedrich-Alexander-Universität Erlangen-Nürnberg2815ERA08E
ZonMw50-52905-98-499
Bundesministerium für Bildung und Forschung01ET1003A, FKZ 01ET0713
Bundesministerium für Ernährung und Landwirtschaft
European Society for Clinical Nutrition and Metabolism
Universität Ulm
Bundesanstalt für Landwirtschaft und Ernährung2815ERA10E
Helmholtz Zentrum München
European Geriatric Medicine Society

    Keywords

    • community-dwelling
    • determinants
    • longitudinal study
    • malnutrition
    • meta-analysis
    • older

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